The purpose of this project is to optimize the function of the referral process to secondary/tertiary medical centers. It is expected that if both the community physician sending the patient and the reference center physicians who take care of the patient feel that the referral is appropriate, then the care provided and the efficiency of the delivery of that care will be of high quality. One objective of this study is to define the expectations that both the sender and receiver of the patient have of each other. These include expectations concerning the purpose of the referral, the communications that take place, the treatment provided, and the continuing educational exchanges. A second objective is to design and carry-out a prospective study of referral patients to both the inpatient and outpatient services to evaluate systems performance. A third objective of the study will be to utilize the data for systems improvements, continuing educational programming and the design of methods for periodic performance monitoring. The methodology involves personal interviews with physicians at the regional reference center and with those physicians in the community who do not refer concerning their expectations. During the prospective study personal interviews will be done with patients during their initial contact with the medical center. After their care has been completed their medical records will be abstracted. Outcome information concerning the referral process and the patients health status will be determined by telephone interviews with the patient/family and the referrral physician. Data analysis will include case by case review, computer analysis of patterns of care, and pertinent corrolations.